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Research Studies is a compilation of published research articles funded by ´óÏóÊÓƵor authored by ´óÏóÊÓƵresearchers.

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1 to 9 of 9 Research Studies Displayed
Koukounas KG, Dixit MN, Thorsness R
Performance of dialysis facilities after health-equity scoring incentive.
This research letter describes the performance of dialysis facilities after the initiation of the Centers for Medicare and Medicaid Services (CMS)’ End-Stage Renal Disease Treatment Choice (ETC) Model, one of the largest randomized evaluations of a pay-for-performance program ever conducted in the United States. The ETC model randomly assigned dialysis centers and nephrologists in approximately 30% of hospital referral regions to receive financial incentives or penalties based on their patients’ receipts of home dialysis, kidney transplantation, and placement on a transplant waiting list. In the first model year (2021), the percentage of dialysis facilities that received financial penalties was substantially higher among facilities that disproportionately served patients with social risk factors. In the second model year (2022), the scoring methodology was changed to implement a health-equity incentive, which created a separate scoring strata according to the percentage of patients with Medicare at a given facility who are dually enrolled in Medicaid or receive low-income subsidies (≥50% vs. <50%). The additional of the health-equity incentive was not accompanied by a change in the disparity in performance between facilities in the lowest and highest social risk cohorts with respect to the use of home dialysis or the achievement of transplantation. However, the introduction of the incentive corresponded to a reduction of 11.8 percentage points in the difference in the percentage of facilities in the highest- and lowest-risk cohorts who received a financial penalty for performance.
AHRQ-funded; HS028285.
Citation: Koukounas KG, Dixit MN, Thorsness R . Performance of dialysis facilities after health-equity scoring incentive. N Engl J Med 2025 Apr 24; 392(16):1657-59. doi: 10.1056/NEJMc2413208.
Keywords: Kidney Disease and Health, Medicare
Adler JT, Kuk AE, Cron DC
Insurance transitions from employer-based insurance to Medicare and waitlisting for kidney transplantation: placing Marietta v. DaVita in context.
In a retrospective cohort study of incident dialysis patients aged 18-62 with employer-sponsored group health plans (EGHPs), researchers found that 36% switched to Medicare before the end of the 30-month coordination period. Patients residing in counties with higher social vulnerability and those with non-commercial dialysis modalities were more likely to switch early. Early switchers were less likely to be waitlisted for kidney transplantation, even after adjusting for various confounders. This association persisted even among patients who maintained their EGHP for at least one month after starting dialysis. These findings highlight the potential impact of recent legal changes allowing EGHPs to decrease dialysis reimbursements, which may increase early switching to Medicare and consequently affect transplant access.
AHRQ-funded; HS028476.
Citation: Adler JT, Kuk AE, Cron DC . Insurance transitions from employer-based insurance to Medicare and waitlisting for kidney transplantation: placing Marietta v. DaVita in context. J Am Soc Nephrol 2024 Apr; 35(4):495-98. doi: 10.1681/asn.0000000000000298..
Keywords: Transplantation, Kidney Disease and Health, Health Insurance, Access to Care, Medicare
Tummalapalli SL, Struthers SA, White D
Optimal care for kidney health: development of a Merit-based Incentive Payment System (MIPS) value pathway.
This article detailed the iterative consensus-building process used by the American Society of Nephrology Quality Committee to develop the Optimal Care for Kidney Health Merit-based Incentive Payment System (MIPS) Value Pathway (MVP). The Optimal Care for Kidney Health MVP, published in the 2023 Medicare Physician Fee Schedule Final Rule, included measures related to angiotensin-converting enzyme inhibitor and angiotensin receptor blocker use, hypertension control, readmissions, acute kidney injury requiring dialysis, and advance care planning. The MVP nephrology’s goal was to streamline measure selection in MIPS and served as a case study of collaborative policymaking between one professional organization and national regulatory agencies.
AHRQ-funded; HS028684.
Citation: Tummalapalli SL, Struthers SA, White D . Optimal care for kidney health: development of a Merit-based Incentive Payment System (MIPS) value pathway. J Am Soc Nephrol 2023 Aug; 34(8):1315-28. doi: 10.1681/asn.0000000000000163..
Keywords: Kidney Disease and Health, Payment, Healthcare Costs, Medicare
Bakre S, Hollingsworth JM, Yan PL
Accountable care organizations and spending for patients undergoing long-term dialysis.
This study analyzed Medicare data to examine time trends in long-term dialysis beneficiary alignment to Accountable Care Organizations (ACOs) and differences in spending for those who were Accountable Care Organization aligned versus nonaligned. Beneficiaries on long-term dialysis between 2009 and 2016 were identified using a 20% random sample of Medicare beneficiaries. Trends in alignment to an ACO alignment were compared with alignment of the general Medicare population. The cohort included 135,152 beneficiaries during the study period. Alignment to an ACO of long-term dialysis beneficiaries increased from 6% to 23% from 2012 to 2016. In the time series analysis, ACO spending was $143 less per beneficiary-quarter than spending for non-aligned beneficiaries. This savings was limited to care by a primary care physician.
AHRQ-funded; HS024525; HS026908; HS024728.
Citation: Bakre S, Hollingsworth JM, Yan PL . Accountable care organizations and spending for patients undergoing long-term dialysis. Clin J Am Soc Nephrol 2020 Dec 7;15(12):1777-84. doi: 10.2215/cjn.02150220..
Keywords: Healthcare Costs, Dialysis, Kidney Disease and Health, Medicare
Childrers CP, Dworsky JQ, Kominski G
A comparison of payments to a for-profit dialysis firm from government and commercial insurers.
The authors assessed differences in payments from government and commercial insurers to dialysis clinics through analysis of DaVita’s financial records. They found that, in 2017, commercial insurers paid one of the largest dialysis suppliers 4 times the rate of their government peers. They recommended that reducing payments from commercial insurers, perhaps through increased competition or fixing charges at a percent of Medicare reimbursement, may help alleviate excess spending on dialysis.
AHRQ-funded; HS025079.
Citation: Childrers CP, Dworsky JQ, Kominski G . A comparison of payments to a for-profit dialysis firm from government and commercial insurers. JAMA Intern Med 2019 Aug;179(8):1136-38. doi: 10.1001/jamainternmed.2019.0431..
Keywords: Payment, Health Insurance, Kidney Disease and Health, Medicare, Medicaid
Ross KH, Jaar BG, Lea JP
Long-term outcomes among Medicare patients readmitted in the first year of hemodialysis: a retrospective cohort study.
This retrospective cohort study examined long-term outcomes among Medicare patients with end-stage renal disease (ESRD) during the first year of hemodialysis. The goal was to determine hospital readmission patterns in the first year of dialysis and outcomes in the second year. Data from the United States Renal Data System (USRDS) was used and readmission patterns were summarized as either no readmission within 30 days, at least one admission, but not within 30 days, and admission with at least one readmission within 30 days. About half of all patients did not get readmitted (51%), but 18.5% were readmitted within 30 days, and 30.5% were admitted but not within 30 days. Those who were readmitted within 30 days had the highest long-term risk of mortality, hospitalization and lower likelihood of kidney transplantation compared to patients who were not admitted or readmitted.
AHRQ-funded; HS025018.
Citation: Ross KH, Jaar BG, Lea JP . Long-term outcomes among Medicare patients readmitted in the first year of hemodialysis: a retrospective cohort study. BMC Nephrol 2019 Jul 29;20(1):285. doi: 10.1186/s12882-019-1473-0..
Keywords: Dialysis, Elderly, Hospital Readmissions, Kidney Disease and Health, Medicare, Outcomes
Hart A, Gustafson SK, Wey A
The association between loss of Medicare, immunosuppressive medication use, and kidney transplant outcomes.
The purpose of this study was to determine the association between the timing of Medicare loss and immunosuppressive medication fills and kidney allograft loss. Findings indicated that the medication possession ratio (MPR) was lower for recipients with early or late Medicare loss compared with no coverage loss for all immunosuppressive medication types. When recipients were matched by age, posttransplant timing of Medicare loss, and donor risk, the hazard of allograft loss was significantly higher after Medicare loss, with no difference in the hazard for on-time Medicare loss.
AHRQ-funded; HS024527.
Citation: Hart A, Gustafson SK, Wey A . The association between loss of Medicare, immunosuppressive medication use, and kidney transplant outcomes. Am J Transplant 2019 Jul;19(7):1964-71. doi: 10.1111/ajt.15293..
Keywords: Kidney Disease and Health, Medicare, Medication, Outcomes, Patient-Centered Outcomes Research, Transplantation
Li Q, Trivedi AN, Galarraga O
Medicare Advantage ratings and voluntary disenrollment among patients with end-stage renal disease.
This study assessed the association between publicly reported Medicare Advantage plan star ratings and voluntary disenrollment of incident dialysis patients in the following year over the period 2007-13. The authors assert that their findings suggest that low plan quality may lead to increased expenditures, as this high-cost population generally must shift from Medicare Advantage to traditional Medicare upon disenrollment.
AHRQ-funded; HS023959.
Citation: Li Q, Trivedi AN, Galarraga O . Medicare Advantage ratings and voluntary disenrollment among patients with end-stage renal disease. Health Aff 2018 Jan;37(1):70-77. doi: 10.1377/hlthaff.2017.0974..
Keywords: Kidney Disease and Health, Medicare
Beaubrun AC, Kanda E, Bond TC
Form CMS-2728 data versus erythropoietin claims data: implications for quality of care studies.
The purpose of this study was to compare predialysis erythropoietin-simulating agents (ESA) care reported on Form CMS-2728 with Medicare claims for ESA treatment submitted for patients 67 years and older at initiation of dialysis with Medicare as the primary payer. It found that the agreement between Form CMS-2728 and claims data is poor and discordant results are observed when comparing the use of these data sources to predict health outcomes.
AHRQ-funded; HS000032.
Citation: Beaubrun AC, Kanda E, Bond TC . Form CMS-2728 data versus erythropoietin claims data: implications for quality of care studies. Ren Fail 2013;35(3):320-6. doi: 10.3109/0886022x.2012.747967..
Keywords: Medicare, Data, Elderly, Quality of Care, Kidney Disease and Health

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